# Utah Medicaid and Wegovy or Zepbound After the Weight-Loss Pilot Ended By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06 Canonical page: https://glpwatchdog.org/research/utah-medicaid-glp1-coverage > Utah Medicaid paid for Wegovy, Zepbound and Saxenda for obesity under a legislative pilot that its form capped at June 30, 2026. What remains: Wegovy for heart disease or MASH, Zepbound for sleep apnea with PAP, and diabetes GLP-1s that need only a diagnosis code. ## Key points - Weight-loss approvals ran under a state pilot and were capped at June 30, 2026, with no new starts. - Wegovy for heart risk needs a BMI of 27 or more and 5% weight loss at 20 weeks to renew. - Zepbound for sleep apnea needs an in-lab study, a sleep specialist and at least 70% PAP use. - Wegovy for MASH needs a liver specialist and two kinds of fibrosis evidence. - Preferred diabetes GLP-1s such as Ozempic and Mounjaro need only a type 2 diabetes code. Not for weight loss anymore. Utah Medicaid paid for Wegovy, Zepbound and Saxenda for obesity through a legislative pilot, and its May 2026 provider bulletin said fee-for-service coverage for weight loss would end June 30, 2026.[10] Its prior authorization form limits those approvals to that date and takes no new starts.[1] As of November 2026 adults can still get Wegovy for heart disease or MASH and Zepbound for sleep apnea, and diabetes GLP-1s need only a diagnosis code.[1][2] > **About this article.** This page reads Utah Medicaid’s GLP-1 request form for weight-related conditions (last updated June 1, 2026), its fee-for-service preferred drug list effective November 1, 2026, its May 2026 provider bulletin and its hearings page, as they stood on November 6, 2026. The bulletin speaks to fee-for-service members, so members in an accountable care plan should confirm the rules with their plan. For every state, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker). ## Can you still get Wegovy or Zepbound for weight loss on Utah Medicaid? No new approvals are possible on the current form, posted June 19, 2026.[3] The obesity box on page one now leads only to a reauthorization section, and that section asks whether the patient already had a weight-loss approval active between July 1, 2025 and June 30, 2026.[1] The prescriber must also acknowledge that this coverage came from a pilot set up by the legislature, one the state warned might stop after June 30, 2026, and the form’s duration table caps those reauthorizations at that date.[1] The state’s May 2026 bulletin settled the question: effective June 30, 2026, fee-for-service Medicaid “will no longer cover GLP-1 agonists, including Wegovy, Saxenda, and Zepbound for weight loss,” while coverage for heart, liver and sleep apnea uses continues.[10] So a person whose only diagnosis is obesity has no route as of November 2026. Under federal law, any state may leave weight-loss drugs out of Medicaid, and the pilot was Utah’s exception to that.[5] Our explainer on [Medicaid and Ozempic or Wegovy](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) covers the federal rules. ## When will Utah Medicaid pay for Wegovy or Zepbound now? For three uses, each limited to adults 18 and older and each requested on the same form.[1] Every request starts with shared conditions: an exercise program and calorie-restricted diet in the chart, no medullary thyroid cancer or MEN2 in the patient or the family, no pregnancy, no second GLP-1, GIP or DPP-4 drug, and a plan to reach the minimum dose needed for renewal within six months.[1] *Utah Medicaid routes on the GLP-1 Weight-related Comorbidities form, last updated June 1, 2026* | Use | Drug | Main requirements | Approval length | | --- | --- | --- | --- | | Weight loss alone | Saxenda, Wegovy, Zepbound | Renewal only, for approvals active July 2025 to June 2026 | No later than June 30, 2026 | | Heart attack and stroke risk | Wegovy (injection or tablet) | BMI of 27 or more; past heart attack, stent, bypass, stroke or symptomatic artery disease in the legs; secondary-prevention treatment | Up to 6 months, then up to 12 | | Moderate to severe sleep apnea | Zepbound | Sleep specialist; BMI of 30 or more; AHI of 15 or more on an in-lab study; PAP use at 70% or more, continued with Zepbound | Up to 12 months | | MASH with F2 to F3 fibrosis | Wegovy injection only | Liver specialist; FIB-4 plus a biopsy, VCTE, ELF or MRE; no cirrhosis or other liver disease | Up to 6 months, then up to 12 | Unlike some states, Utah’s form does not print a diabetes exclusion on these three routes.[1] It does point anyone using Ozempic, Mounjaro or another diabetes GLP-1 to the drug list instead.[1] ## What does Utah require for Wegovy after a heart attack or stroke? A BMI of at least 27 and a past heart attack, a coronary stent or bypass, a stroke, or symptomatic peripheral artery disease, shown by leg pain with an ankle-brachial index under 0.85, a revascularization or an amputation.[1] The patient must also be on the usual secondary-prevention care.[1] Listing stents and bypass surgery widens the route a little beyond a strict heart-attack history; the Wegovy label itself speaks of established cardiovascular disease with obesity or overweight.[6] The renewal test is concrete: after 20 weeks the patient must have lost at least 5% of baseline weight and kept it off, and must still be on secondary-prevention treatment.[1] Our article on GLP-1s after a heart attack covers what the heart trial measured. ## Does Utah Medicaid cover Zepbound for sleep apnea? Yes, with conditions stricter than the label. A neurologist, pulmonologist, ear, nose and throat doctor or other sleep specialist must prescribe or consult. The patient needs a BMI of at least 30 and an AHI of 15 or more on an in-lab attended study or polysomnography, so a home sleep test may not be enough.[1] The patient must also be using positive airway pressure at least 70% of the time and keep using it alongside Zepbound, unless they cannot tolerate it or the prescriber gives another reason.[1] Renewal needs the AHI to drop by at least 20%, or the apnea to reach remission or mild, symptom-free status.[1] The Zepbound label covers moderate to severe sleep apnea in adults with obesity and sets no PAP condition.[7] Our guide to [Zepbound for sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) covers the trials. ## Will Utah Medicaid cover Wegovy for MASH? Yes, for the injection only. A gastroenterologist, hepatologist or other liver specialist must prescribe or consult, and fibrosis must be stage F2 or F3 on two kinds of evidence: an age-adjusted FIB-4 score plus a biopsy, a vibration-controlled transient elastography scan, an ELF score or MR elastography.[1] Decompensated cirrhosis, moderate to severe liver impairment and other liver diseases such as hepatitis or liver cancer all disqualify.[1] To renew, the patient must be on the 2.4 mg dose, or 1.7 mg if the higher one is not tolerated, after 17 weeks, with chart notes showing a positive response.[1] The FDA approved this use on an accelerated basis; our page on [GLP-1s for MASH](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) explains the evidence.[6] ## Does Utah Medicaid cover Ozempic and Mounjaro for diabetes? Yes, and with less paperwork than the other routes. On the November 2026 fee-for-service list, Mounjaro, Ozempic injection, Trulicity and Victoza are preferred, and the prescriber writes a type 2 diabetes diagnosis code on the prescription rather than filing a prior authorization.[2] Mounjaro, Trulicity and Victoza start at age 10 and Ozempic at 18.[2] The list limits this class to type 2 diabetes and allows one GLP-1 a month.[2] Rybelsus, the Ozempic tablet and the rest are non-preferred and need a coverage exception.[2] ## How do you appeal a Utah Medicaid denial? Start with the denial reason. A missing in-lab sleep study, PAP record or second liver test is usually fixed by refiling with it; the fax for pharmacy requests is 855-828-4992.[1] A request for weight loss alone has little to argue, because fee-for-service coverage for that use ended June 30, 2026.[10] Formal hearings are handled by the state health department’s hearings office, by form, email or mail to PO Box 143105, Salt Lake City, UT 84114-3105; its phone is 801-538-6576.[4] Members of an accountable care organization must finish their plan’s appeal first.[4] The state’s hearings page gives 90 days from the notice for eligibility and disability decisions but names no separate deadline for drug denials, so go by the date on your notice.[4] Our guide to [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers the file, and the [Utah state page](https://glpwatchdog.org/states/utah) has the Medicaid facts in brief. ## What are the options for weight loss without Utah Medicaid? Manufacturer copay cards do not help: Lilly’s Zepbound card terms exclude anyone in a government-funded program, Medicaid included.[8] In the self-pay prices we track, Novo Nordisk charges $349 a month for most Wegovy pen doses, and Lilly charges $299 for Zepbound at the starting dose, $399 at 5 mg and $449 at 7.5 mg and up when each refill comes within 45 days.[8][9] Our list of the [cheapest ways to pay for a GLP-1 without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares the options. ## Frequently asked questions ### Does Utah Medicaid cover Wegovy for weight loss? Not as of November 2026. Weight-loss coverage was a legislative pilot, and Utah Medicaid said fee-for-service coverage for weight loss would end June 30, 2026. Its form takes no new weight-loss starts. Wegovy can still be approved for an adult who has had a heart attack, stent, bypass or stroke and whose BMI is at least 27, or for MASH with F2 to F3 fibrosis. ### Did Utah Medicaid's GLP-1 weight-loss pilot end? Yes, for fee-for-service members. Utah Medicaid's May 2026 provider bulletin said that effective June 30, 2026 it would no longer cover Wegovy, Saxenda or Zepbound for weight loss, and it would keep covering them for heart disease, MASH and sleep apnea. The prior authorization form also caps weight-loss renewals at that date. Members of an accountable care plan should confirm with their plan. ### Does Utah Medicaid cover Zepbound for sleep apnea? Yes. An adult needs a BMI of at least 30 and an in-lab sleep study showing an AHI of at least 15, and the drug must be prescribed by or with a sleep specialist. The patient must use positive airway pressure at least 70% of the time and continue it, unless they cannot tolerate it. Approvals last up to 12 months. ### Do I need prior authorization for Ozempic on Utah Medicaid? Not on the November 2026 fee-for-service list. Ozempic injection, Mounjaro, Trulicity and Victoza are preferred, and the prescriber writes a type 2 diabetes diagnosis code on the prescription. Rybelsus and other non-preferred GLP-1s need a coverage exception. ### Where do I request a Utah Medicaid hearing? Hearing requests go to the hearings office of Utah's health department by form, email or mail, and its phone number is 801-538-6576. Members of an accountable care organization must finish their plan's appeal process first. Use the deadline printed on your notice. ## References 1. Utah Department of Health and Human Services, Medicaid Pharmacy Prior Authorization Request Form: GLP-1 Medications for Weight-related Comorbidities (Saxenda, Wegovy, Zepbound), last updated June 1, 2026. medicaid-documents.dhhs.utah.gov. 2026. https://medicaid-documents.dhhs.utah.gov/pharmacy%2Fpriorauthorization%2Fpdf%2FGLP-1+Medications+for+Weight-related+Comorbidities.pdf 2. Utah Department of Health and Human Services, Medicaid Pharmacy Utah Medicaid Fee-for-Service Preferred Drug List, effective November 1, 2026. medicaid-documents.dhhs.utah.gov. 2026. https://medicaid-documents.dhhs.utah.gov/pharmacy%2FPDL%2Ffiles%2FUtah+Medicaid+PDL+%2811-01-26%29.pdf 3. Utah Department of Health and Human Services Medicaid Pharmacy: Prior Authorization forms and contacts. medicaid.utah.gov. 2026. https://medicaid.utah.gov/pharmacy/prior-authorization/ 4. Utah Department of Health and Human Services Medicaid Hearings. medicaid.utah.gov. 2026. https://medicaid.utah.gov/hearings/ 5. United States Code 42 U.S.C. §1396r-8: Payment for covered outpatient drugs (Social Security Act §1927). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396r-8 6. Novo Nordisk WEGOVY (semaglutide) injection and tablets: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b 7. Eli Lilly and Company ZEPBOUND (tirzepatide) injection: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b 8. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 9. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html 10. Utah Department of Health and Human Services, Medicaid Medicaid Information Bulletin, May 2026: 26-45 GLP-1 Agonists for Weight Loss. medicaid-documents.dhhs.utah.gov. 2026. https://medicaid-documents.dhhs.utah.gov/Documents%2Fmanuals%2Fpdfs%2FMedicaid+Information+Bulletins%2FTraditional+Medicaid+Program%2F2026%2FMay2026-MIB.pdf --- Cite as: GLP Watchdog, Nora Bissett, "Utah Medicaid and Wegovy or Zepbound After the Weight-Loss Pilot Ended", published 2026-11-06. https://glpwatchdog.org/research/utah-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/utah-medicaid-glp1-coverage Medical disclaimer: Nothing here is medical advice. We report on this subject; we do not treat anyone. Whether to begin a medication, supplement, or treatment, whether to adjust it, and whether to stop are questions for a clinician licensed to answer them, who knows your history.